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Energy metabolism in Bardet-Biedl syndrome

INTRODUCTION: Obesity is a consistent presenting feature of the Bardet-Biedl syndrome (BBS), a hereditary disorder caused by a single gene defect. This contrasts sharply with general obesity which, despite a strong hereditary component, has a multifactorial aetiology. For BBS, the phenotypic characterisation of the components of energy balance and the implications for their management remains relatively uninvestigated. OBJECTIVE: A case-control study to determine whether energy metabolism in subjects with BBS differs from matched obese controls and to inform the clinical management of these patients. METHODS: A total of 20 overweight and obese subjects with BBS (11 females, 9 males) matched for age, gender and BMI to 20 subjects without BBS. Resting metabolic rate (RMR) was measured by indirect calorimetry, physical activity by CSA accelerometry, body composition by the deuterium dilution technique and dietary intake by 7-day food records. RESULTS: There was no significant difference between BBS and control subjects in body fat (male: % fat = 38, s.d. 2.8 vs 34, s.d. 9.1, female: % fat = 45, s.d. 5.9 vs 44, s.d. 8.1; P = 0.46] or absolute RMR (male: 6.95, s.d. 1.55 MJ/day vs 7.19, s.d. 1.28 MJ/ day; P = 0.6). After adjustment for gender, age, fat-free mass and fat mass, there was no significant difference in RMR between BBS and control subjects (F(1, 30) = 0. 91; P = 0.35). A lower level of physical activity was observed in BBS subjects (median cnts/ min 259, IQR = 153) compared to controls (median cnts/min = 306, IQR = 119, P = 0.02). Reported energy intake, macronutrient composition and magnitude of under-reporting were comparable in both groups. CONCLUSION: This study reveals no evidence for systematic differences in energy metabolism in subjects with BBS relative to other obese individuals, suggesting that the genetic basis of BBS is not associated with specific abnormalities in energy metabolism. This is an important finding for clinical management and supports the use of energy prescriptions based on RMR for the general obese population plus an appropriate allowance for energy expended via physical activity. Further research is needed on physical activity in BBS.